Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-15T09:24:13.435Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive Mediation of Cognitive-Behavioural Therapy Outcomes for Anxiety-Based School Refusal

Published online by Cambridge University Press:  28 September 2012

Marija Maric ,
David A. Heyne ,
David P. MacKinnon ,
Brigit M. van Widenfelt  and
P. Michiel Westenberg
Marija Maric*
Affiliation:
Leiden University Institute of Psychology, the Netherlands
David A. Heyne
Affiliation:
Leiden University Institute of Psychology, the Netherlands
David P. MacKinnon
Affiliation:
Arizona State University, Tempe, USA
Brigit M. van Widenfelt
Affiliation:
Leiden University Medical Center, the Netherlands
P. Michiel Westenberg
Affiliation:
Leiden University Institute of Psychology, the Netherlands
*
Reprint requests to Marija Maric, Department of Developmental Psychology, University of Amsterdam, Weesperplein 4, 1018 XA, Amsterdam, the Netherlands. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Cognitive-behavioural therapy (CBT) has proven to be effective for anxiety-based school refusal, but it is still unknown how CBT for school refusal works, or through which mechanisms. Aims: Innovative statistical approaches for analyzing small uncontrolled samples were used to investigate the role of self-efficacy in mediating CBT outcomes for anxiety-based school refusal. Method: Participants were 19 adolescents (12 to 17 years) who completed a manual-based cognitive-behavioural treatment. Primary outcomes (school attendance; school-related fear; anxiety) and secondary outcomes (depression; internalizing problems) were assessed at post-treatment and 2-month follow-up. Results: Post-treatment increases in school attendance and decreases in fear about attending school the next day were found to be mediated by self-efficacy. Mediating effects were not observed at 2-month follow-up. Conclusions: These findings provide partial support for the role of self-efficacy in mediating the outcome of CBT for school refusal. They contribute to a small body of literature suggesting that cognitive change enhances CBT outcomes for young people with internalizing problems. Regarding methodology, the product of coefficient test appears to be a valuable way to study mediation in outcome studies involving small samples.

Keywords

CBTmediatorsschool refusalanxietyself-efficacy
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 41 , Issue 5 , October 2013 , pp. 549 - 564
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abela, J. R. Z. and Hankin, B. (2008). Cognitive vulnerability to depression in children and adolescents: a developmental psychopathology perspective. In Abela, J. R. Z. and Hankin, B. L. (Eds.), Handbook of Depression in Children and Adolescents (pp. 35–78). New York: The Guilford Press.Google Scholar
Achenbach, T. M. (1991). Manual for the Child Behavior Checklist/4-18 and 1991 Profile. Burlington, VT: University of Vermont Department of Psychiatry.Google Scholar
Alfano, C. A., Pina, A. A., Villalta, I. K., Beidel, D. C., Ammerman, R. T. and Crosby, L. E. (2009). Mediators and moderators of outcome in the behavioural treatment of childhood social phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 945–953.CrossRefGoogle ScholarPubMed
Bandura, A. (1994). Self-efficacy. In Ramachaudran, V. S. (Ed.), Encyclopedia of Human Behavior (Vol. 4, pp. 71–81). New York: Academic Press. (Reprinted in Friedman, H. [Ed.], Encyclopedia of Mental Health. San Diego: Academic Press, 1998).Google Scholar
Bandura, A., Adams, N. E. and Beyer, J. (1977). Cognitive processes mediating behavioural change. Journal of Personality and Social Psychology, 35, 125–139.CrossRefGoogle Scholar
Baron, R. M. and Kenny, D. A. (1986). The moderator mediator variable distinction in social psychological-research - conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.CrossRefGoogle ScholarPubMed
Berg, I. (2002). School avoidance, school phobia, and truancy. In Lewis, M. (Ed.), Child and Adolescent Psychiatry: a comprehensive textbook (3rd ed.) (pp. 1260–1266). Sydney: Lippincott Williams and Wilkins.Google Scholar
Berg, I., Nichols, K. and Pritchard, C. (1969). School phobia: its classification and relationship to dependency. Journal of Child Psychology and Psychiatry, 10, 123–141.CrossRefGoogle ScholarPubMed
Bernstein, G. A., Massie, E. D., Thuras, P. D. and Perwein, A. R. (1997). Somatic symptoms in anxious-depressed school refusers. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 661–668.CrossRefGoogle ScholarPubMed
Bernstein, G. A., Borchardt, C. M., Perwien, A. R., Crosby, R. D., Kushner, M. G., Thuras, P. D., et al. (2000). Imipramine plus cognitive-behavioral therapy in the treatment of school refusal. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 276–283.CrossRefGoogle ScholarPubMed
Bouchard, S., Gauthier, J., Nouwen, A., Ivers, H., Vallieres, A., Simard, S., et al. (2007). Temporal relationship between dysfunctional beliefs, self-efficacy and panic apprehension in the treatment of panic disorder with agoraphobia. Journal of Behaviour Therapy and Experimental Psychiatry, 38, 275–292.CrossRefGoogle ScholarPubMed
Braet, C. and Timbremont, B. (2002). Children's Depression Inventory - Dutch version. Amsterdam: Harcourt Test Publishers.Google Scholar
Chu, B. C. and Harrison, T. L. (2007). Disorder-specific effects of CBT for anxious and depressed youth: a meta-analysis of candidate mediators of change. Clinical Child and Family Psychology Review, 10, 352–372.CrossRefGoogle ScholarPubMed
Cole, D. A. and Maxwell, , , S. E. (2003). Testing mediational models with longitudinal data: questions and tips in the use of structural equation modeling. Journal of Abnormal Psychology, 112, 558–577.CrossRefGoogle ScholarPubMed
DeRubeis, R. J., Evans, M. D., Hollon, S. D., Garvey, M. J., Grove, W. M. and Tuason, V. B. (1990). How does cognitive therapy work: cognitive change and symptom change in cognitive therapy and pharmacotherapy for depression. Journal of Consulting and Clinical Psychology, 58, 862–869.CrossRefGoogle ScholarPubMed
DeRubeis, R. J. and Feeley, M. (1990). Determinants of change in cognitive therapy for depression. Cognitive Therapy and Research, 14, 469–482.CrossRefGoogle Scholar
Duizer, L. (2007). Evaluation of the Dutch Self-Efficacy Questionnaire for School Situations: convergent validity and test-retest reliability. Unpublished Master thesis, Leiden University, the Netherlands.Google Scholar
Dworkin, S. L., Exner, T., Melendez, R., Hoffman, S. and Ehrhardt, A. A. (2006). Revisiting success: posttrial analysis of a gender-specific HIV/STD prevention intervention. Aids and Behavior 10, 41–51.CrossRefGoogle ScholarPubMed
Egger, H. L., Costello, E. J. and Angold, A. (2003). School refusal and psychiatric disorders: a community study. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 797–807.CrossRefGoogle ScholarPubMed
Heyne, D. (1999). Evaluation of Child Therapy and Caregiver Training in the Treatment of School Refusal. Unpublished doctoral dissertation. Monash University, Melbourne, Australia.Google Scholar
Heyne, D. (2006). School refusal. In Fisher, J. E. and O'Donohue, W. T. (Eds.), Practitioner's Guide to Evidence-Based Psychotherapy (pp. 599–618). New York: Springer.Google Scholar
Heyne, D. and King, N. J. (2004). Treatment of school refusal. In Barrett, P. M. and Ollendick, T. H. (Eds.), Handbook of Interventions that Work with Children and Adolescents: prevention and treatment (pp. 243–272). Chichester: John Wiley and Sons.CrossRefGoogle Scholar
Heyne, D., King, N., Tonge, B., Rollings, S., Pritchard, M., Young, D. and Myerson, N. (1998). The Self-Efficacy Questionnaire for School Situations: development and psychometric evaluation. Behaviour Change, 15, 31–40.CrossRefGoogle Scholar
Heyne, D., King, N. J., Tonge, B., Rollings, S., Young, D., Pritchard, M., et al. (2002). Evaluation of child therapy and caregiver training in the treatment of school refusal. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 687–695.CrossRefGoogle ScholarPubMed
Heyne, D., Maric, M., Duizer, L., Sijtsma, C. and Van den Leden, S. (2007). Self Efficacy Questionnaire for School Situations-Dutch Version. Unpublished measure, Leiden University, the Netherlands.Google Scholar
Heyne, D. and Rollings, S. (2002). School Refusal. Oxford: Blackwell Scientific Publications.Google ScholarPubMed
Heyne, D. and Sauter, F. (2012). School Refusal. In Essau, C. A. and Ollendick, T. H. (Eds.), The Wiley-Blackwell Handbook of the Treatment of Childhood and Adolescent Anxiety. Chichester: John Wiley and Sons.Google Scholar
Heyne, D., Sauter, F. M. and van Hout, R. (2008). The @School Program: modular cognitive behaviour therapy for school refusal in adolescence. Unpublished treatment manual. Leiden University, the Netherlands: Faculty of Social and Behavioural Sciences.Google Scholar
Heyne, D., Sauter, F. M., van Widenfelt, B. M., Vermeiren, R. and Westenberg, P. M. (2011). School refusal and anxiety in adolescence: non-randomized trial of a developmentally-sensitive cognitive behavioural therapy. Journal of Anxiety Disorders, 25, 870–878.CrossRefGoogle Scholar
Holmbeck, G. N. (1997). Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: examples from the child-clinical and pediatric psychology literatures. Journal of Consulting and Clinical Psychology, 65, 599–610.CrossRefGoogle Scholar
Hudson, J. L. (2005). Efficacy of cognitive-behavioural therapy for children and adolescents with anxiety disorders. Behaviour Change 22, 55–70.CrossRefGoogle Scholar
Hudson, J. L., Rapee, R. M., Deveney, C., Schniering, C. A., Lyneham, H. L. and Bovopoulos, N. (2009). Cognitive-behavioural treatment versus an active control for children and adolescents with anxiety disorders: a randomized trial. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 533–544.CrossRefGoogle Scholar
Kaufman, N. K., Rohde, P., Seeley, J. R., Clarke, G. N. and Stice, E. (2005). Potential mediators of cognitive-behavioural therapy for adolescents with comorbid major depression and conduct disorder. Journal of Consulting and Clinical Psychology, 73, 38–46.CrossRefGoogle ScholarPubMed
Kazdin, A. E. and Nock, M. K. (2003). Delineating mechanisms of change in child and adolescent therapy: methodological issues and research recommendations. Journal of Child Psychology and Psychiatry, 44, 1116–1129.CrossRefGoogle ScholarPubMed
Kearney, C. A. (2007). Forms and functions of school refusal behavior in youth: an empirical analysis of absenteeism severity. Journal of Child Psychology and Psychiatry, 48, 53–61.CrossRefGoogle ScholarPubMed
Kearney, C. A. and Albano, A. M. (2007). When Children Refuse School: a cognitive-behavioural therapy approach/Therapist's guide (2nd ed.). New York: Oxford University Press.CrossRefGoogle Scholar
Kearney, C. A., Eisen, A. R. and Silverman, W. K. (1995). The legend and myth of school phobia. School Psychology Quarterly, 10, 65–85.CrossRefGoogle Scholar
Kendall, P. C. and Treadwell, K. R. H. (2007). The role of self-statements as a mediator in treatment for youth with anxiety disorders. Journal of Consulting and Clinical Psychology 75, 380–389.CrossRefGoogle ScholarPubMed
King, N. and Bernstein, G. A. (2001). School refusal in children and adolescents: a review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 197–205.CrossRefGoogle ScholarPubMed
King, N. J., Tonge, B. J., Heyne, D., Pritchard, M., Rollings, S., Young, D., et al. (1998). Cognitive-behavioural treatment of school-refusing children: a controlled evaluation. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 395–403.CrossRefGoogle Scholar
Kleinknecht, R. A. and Bernstein, D. A. (1988). Fear thermometer. In Hersen, M. and Bellack, A. S. (Eds.), Dictionary of Behavioural Assessment Techniques (pp. 220–221). New York: Pergamon Press.Google Scholar
Kovacs, M. (1992). Children's Depression Inventory. New York: Multi-Health Systems, Inc.Google Scholar
Kraemer, H. C., Wilson, G. T., Fairburn, C. G. and Agras, W. S. (2002). Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry, 59, 877–883.CrossRefGoogle ScholarPubMed
Last, C. G., Hansen, C. and Franco, N. (1998). Cognitive-behavioural treatment of school phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 404–411CrossRefGoogle Scholar
MacKinnon, D. P. (2008). Introduction to Statistical Mediation Analysis. Mahwah, NJ: Erlbaum.Google Scholar
MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G. and Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83–104.CrossRefGoogle ScholarPubMed
MacKinnon, D. P., Lockwood, C. M. and Williams, J. (2004). Confidence limits for the indirect effect: distribution of the product and resampling methods. Multivariate Behavioural Research 39, 99–128.CrossRefGoogle ScholarPubMed
Mansdorf, I. J. and Lukens, E. (1987). Cognitive-behavioural psychotherapy for separation anxious children exhibiting school phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 222–225.CrossRefGoogle Scholar
March, J. S., Parker, J. D. A., Sullivan, K., Stallings, P. and Conners, K. (1997). The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 554–565.CrossRefGoogle ScholarPubMed
Maric, M., Heyne, D. A., de Heus, P., van Widenfelt, B. M. and Westenberg, P. M. (2011). The role of cognition in school refusal: an investigation of automatic thoughts and cognitive errors. Behavioural and Cognitive Psychotherapy, 29, 1–15.Google Scholar
McNamara, E. (1988). The self-management of school phobia: a case study. Behavioural Psychotherapy, 16, 217–229.CrossRefGoogle Scholar
Moscovitch, D. A., Hofmann, S. G., Suvak, M. K. and In-Albon, T. (2005). Mediation of changes in anxiety and depression during treatment of social phobia. Journal of Consulting and Clinical Psychology, 73, 945–952.CrossRefGoogle ScholarPubMed
Muris, P., Gadet, B., Moulaert, V. and Merckelbach, H. (1998). Correlations between two multi dimensional anxiety scales for children. Perceptual and Motor Skills, 87, 269–270.CrossRefGoogle Scholar
Muris, P., Merckelbach, H. and Luitjen, M. (2002). The connection between cognitive development and specific fears and worries in normal children and children with below-average intellectual abilities: a preliminary study. Behaviour Research and Therapy, 40, 37–56.CrossRefGoogle ScholarPubMed
Okuyama, M., Okada, M., Kuribayashi, M. and Kaneko, S. (1999). Factors responsible for the prolongation of school refusal. Psychiatry and Clinical Neurosciences, 53, 461–469.CrossRefGoogle ScholarPubMed
Ollendick, T. H. (1983). Reliability and validity of the Revised Fear Survey Schedule for Children (FSSC-R). Behaviour Research and Therapy, 21, 685–692.CrossRefGoogle Scholar
Oosterlaan, J., Prins, P. J. M., Hartman, C. A. and Sergeant, J. A. (1995). Vragenlijst voor Angst bij Kinderen (VAK): Zelfrapportagevragenlijst voor angst bij kinderen van 6–12 jaar. Een Nederlandse bewerking van de Fear Survey Schedule for Children-Revised (FSSCR). Handleiding. [Dutch Adaptation of the Fear Survey Schedule for Children.] Lisse: Swets Test Services.Google Scholar
Pina, A., Zerr, A. A., Gonzales, N. A. and Ortiz, C. D. (2009). Psychosocial interventions for school refusal behavior in children and adolescents. Child Development Perspectives, 3, 11–20.CrossRefGoogle ScholarPubMed
Place, M., Hulsmeier, J., Davis, S. and Taylor, E. (2000). School refusal: a changing problem which requires a change of approach? Clinical Child Psychology and Psychiatry, 5, 345–355.CrossRefGoogle Scholar
Place, M., Hulsmeier, J., Davis, S. and Taylor, E. (2002). The coping mechanisms of children with school refusal. Journal of Research in Special Educational Needs, 2, doi:10.1111/j.1471-3802.2002.00167.xCrossRefGoogle Scholar
Prins, P. J. M. and Ollendick, T. H. (2003). Cognitive change and enhanced coping: missing mediational links in cognitive behavior therapy with anxiety-disordered children. Clinical Child and Family Psychology Review, 6, 87–105.CrossRefGoogle ScholarPubMed
Rynn, M. A., Barber, J. P., Khalid-Khan, S., Siqueland, L., Dembiski, M., McCarthy, K. S., et al. (2006). The psychometric properties of the MASC in a pediatric psychiatric sample. Journal of Anxiety Disorders, 20, 139–157.CrossRefGoogle Scholar
Sauter, F. M., Heyne, D. and Westenberg, P. M. (2009). Cognitive behavior therapy for anxious adolescents: developmental influences on treatment design and delivery. Clinical Child and Family Psychology Review, 12, 310–335.CrossRefGoogle ScholarPubMed
Siebelink, B. M. and Treffers, P. D. A. (2001). The Dutch Adaptation of the Anxiety Disorders Interview Schedule for DSM-IV –Parent/Child Version [by Silverman, W. K. and Albano, A. M., 1996]. Lisse: Swets Test Publishers.Google Scholar
Silverman, W. K. and Albano, A. M. (1996). Anxiety Disorders Interview Schedule for DSM-IV, Child and Parent Versions. San Antonia, TX: Psychological Corporation.Google Scholar
Silverman, W. K., Kurtines, W. M., Ginsburg, G. S., Weems, C. F., Rabian, B. and Serafini, L. T. (1999). Contingency management, self-control, and education support in the treatment of childhood phobic disorders: a randomized clinical trial. Journal of Consulting and Clinical Psychology, 67, 675–687.CrossRefGoogle ScholarPubMed
Silverman, W. K., Pina, A. A. and Viswesvaran, C. (2008). Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 37, 105–130.CrossRefGoogle ScholarPubMed
Stevens, J. (2002). Applied Multivariate Statistics for the Social Sciences (4th ed.). Hillsdale, NL: Erlbaum.Google Scholar
Treadwell, K. R. H. and Kendall, P. C. (1996). Self-talk in youth with anxiety disorders: states of mind, content specificity, and treatment outcome. Journal of Consulting and Clinical Psychology 64, 941–950.CrossRefGoogle ScholarPubMed
Utens, E. M. W. J. and Ferdinand, R. F. (2000). The Dutch Translation of the MASC (MASC-NL). Erasmus University, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Rotterdam, the Netherlands.Google Scholar
Van der Leden, S. (2008). Factor Structure of the Dutch Self-Efficacy Questionnaire for School Situations. Unpublished Master thesis, Leiden University, the Netherlands.Google Scholar
Verhulst, F. C., Van der Ende, J. and Koot, H. M. (1996). Handleiding voor de CBCL (4–18) [Manual for the CBCL (4–18)]. Erasmus University, Department of Child and Adolescent Psychiatry, Sophia Children's Hospital, Rotterdam, the Netherlands.Google Scholar
Weersing, V. R. and Weisz, , , J. R. (2002). Mechanisms of action in youth psychotherapy. Journal of Child Psychology and Psychiatry, 43, 3–29.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.